Organization*

Street Address*

City*

State*

Zip Code*

Phone Number*

Email*

Contact Name*

Preferred Fundraiser Program*
Work at Wiggy’s for a daySell prepaid passesHand out vouchersSilent Auctions and Raffles

Second Choice Fundraiser Program
Work at Wiggy’s for a daySell prepaid passesHand out vouchersSilent Auctions and Raffles

Dates requested for fundraiser*

Reason for donation*

* Indicates required field.